Employment History

No Previous Employers?

Present or Last Employer

Describe your work in detailReason for LeavingName of SupervisorPosition/Title of SupervisorSupervisor Phone Number

If this is your present employer, may we contact?NoYes

2nd Previous Employer

Position/TitleEmployer / Company NameAddressCityState

Start date

Month:Year:Rate:

End date

Month:Year:Rate:

Describe your work in detailReason for LeavingName of SupervisorPosition/Title of SupervisorSupervisor Phone Number

3rd Previous Employer

Position/TitleEmployer / Company NameAddressCityState

Start date

Month:Year:Rate:

End date

Month:Year:Rate:

Describe your work in detailReason for LeavingName of SupervisorPosition/Title of SupervisorSupervisor Phone Number

4th Previous Employer

Position/TitleEmployer / Company NameAddressCityState

Start date

Month:Year:Rate:

End date

Month:Year:Rate:

Describe your work in detailReason for LeavingName of SupervisorPosition/Title of SupervisorSupervisor Phone Number

Step 4 of 6

Professional Qualifications

Have you ever served in the armed forces of the United States?NoYes

If YES, what branch?

Start date

Month:Year:

End date

Month:Year:

Rank at discharge

What were your duties in the Service?

If there was any special training you received in the Service, please describe.

Have you ever been bonded?NoYes

If YES, what job(s)?

Step 5 of 6

Education

Elementary School

Name of School / Issuing AgencyCityState

Years Completed

Did you graduate/receive a degree?NoYes

High School or Equivalent

Name of School / Issuing AgencyCityState

Years Completed

Did you graduate/receive a degree?NoYes

If NOT, did you receive a GED?NoYes

College/Other #1

Name of School / Issuing AgencyCityState

Years Completed

Did you graduate/receive a degree?NoYes

Major & Minor Fields of Study

College/Other #2

Name of School / Issuing AgencyCityState

Years Completed

Did you graduate/receive a degree?NoYes

Major & Minor Fields of Study

List any special training or skill development that might apply to this positionList any honors and extra curricular activities that may relate

Step 6 of 6

Emergency & Certification

Person to be notified in case of accident or emergency

NameAddressPhone Number

Immigration Reform and Control Act of 1986

I understand that if hired, I will be required to offer for examination documents proving that I am a United States citizen or an alien currently authorized to work in the United States. I also understand that my continued employment is contingent upon my providing the necessary documentation within the prescribed time frames.

Applicant's Certification and Agreement

I authorize investigation of my personal or employment history, and of all statements contained in this application. I authorize any former employer, person, firm, corporation, credit agency, or government agency to report any information they may have regarding me, and I release all providers of information from any liability as a result of furnishing this information. I understand that any misrepresentation or omissions in this application shall be considered cause for disqualification from further consideration for hire or for dismissal if discovered subsequent to being hired.

I agree to conform to the rules and regulations of the Company and understand and agree that, if hired, my employment is for no definite period and may, regardless of my designated pay period or salary, be terminated at anytime, for any reason, without any previous notice, at either my or the Company's option. I also understand and agree that no employee of the Company, other than the President, has any authority to enter into any agreement for employment for a specified period, or to make any agreement or representation contrary to the provisions of this Application and Agreement.

The information provided herein is true and accurate to the best of my knowledge. I understand that in the event of information I have provided is found to be untrue or inaccurate then this application may be rejected and/or my employment terminated.

By clicking SUBMIT, I acknowledge that I have read, understand and agree to all of the above statements.

Rechek's Food Pride has been doing business in Beaver Dam, Wisconsin since 1985. At Rechek's we specialize in treating our customers with TLC!